Page 115 - Livre électronique des RFTP 2024

MANAGEMENT OF HYPERSENSITIVITY REACTIONS
TO FIRST-LINE ANTI-TUBERCULOSIS DRUGS

GHIZAOUI ZAINEB - SLIM AZZA - BEN SASSI SARRA - BEN MANSOUR AMANI -
DAGHFOUS HAFAOUA- BEN SAAD SOUMAYA - TRITAR FATMA

HOPITAL ABDERRAHMANE MAMI

INTRODUCTION

The occurrence of hypersensitivity reactions to anti-tuberculosis drugs poses a
problem for the management of tuberculosis disease.

The aim of our work is to describe the management of a patient who presented a
hypersensitivity reaction to first-line antituberculosis treatment

Methods :
This was a retrospective study carried out in the Pneumology Department, Pavilion
C, Abderrahmane Mami Hospital, over a period from January 2011 to March 2023. It
included tuberculosis patients who presented a hypersensitivity reaction to anti-
tuberculosis drugs confirmed by a drug reintroduction test.

RESULTS :

Forty-nine patients were included, with a sex ratio (M/F) of 0.6. Hypersensitivity
reactions to anti-tuberculosis drugs were variable, dominated by skin involvement,
reported in 93.8% of patients. Bronchospasm was noted in 2 patients,
thrombocytopenia in two and anaphylactic shock in three. The immediate
response to hypersensitivity reactions was to stop anti-tuberculosis treatment
(65.3%), add antihistamines (85.7%) and start corticosteroids in 10 cases (20.4%). In 12
patients, the hypersensitivity reaction was considered a minor adverse event,
requiring only the addition of antihistamine treatment. In the other patients, the
anti-tuberculosis treatment reintroduction test revealed monosensitization to anti-
tuberculosis treatments in 29 patients (78.4%), and polyallergy in 8 patients (21.6%).
Ultra-rapid oral addiction to anti-tuberculosis treatments was indicated in 16
patients. Eight cases of success were recorded, enabling the same treatment to be
maintained. In 21 cases (72.4%), the allergenic drug was discontinued. Among
patients presenting polysensitization, a successful habituation to Isoniazid and
Rifampicin was carried out in only one patient, who was kept on the same initial
protocol; in the other patients, the allergenic drug was stopped and substituted by
a 2nd-line drug.

CONCLUSION :

The drug reintroduction test is a key element in the investigation of anti-
tuberculosis hypersensitivity reactions. The immediate and long-term course of

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